Mini Laparoscopy (Scarless Laparoscopy)
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The laparoscopic approach allows the surgeon to perform many surgeries that can be performed with traditional open surgery through a smaller incision. To date, studies have shown that laparoscopic surgery has great benefits to the patient, including reduced bleeding and postoperative pain, shorter hospital stay, and earlier return to normal physical activity and work. In addition to these advantages, with the laparoscopic approach, patients can expect better cosmetic results and reduce the risk of wound infection which is one of the most common postoperative problems.
What is Mini-Laparoscopy?
The term "Mini-Laparoscopy" is very broad term and covers all techniques that use smaller incisions and/or smaller instruments. Mini-laparoscopy is designed to be simple and effective to facilitate the insertion of instruments. There is no need to close the skin at the end of the procedure and the scar is smaller. These instruments can also be used as an adjunct to conventional laparoscopy in cases requiring additional procedures. In pediatric patients, it provides image and skill equivalent to a large incision. This means less pain and faster recovery in these children.
Design of Mini-Laparoscopy
Mini-laparoscopy instruments range in size from 2.3 mm to 3.5 mm and entrance can be assessed with both insertion needles and trocars. Although they are small in size, these instruments are built to have increased durability and to allow for proper manipulation and traction of the tissue. Mini-laparoscopy also produces good quality images which are comparable to larger instruments. Due to the small diameter of the mini-laparoscopy, fascia and skin do not need to be stitched, thus eliminating cosmetic concerns of the patients.
What is Micro-Laparoscopy?
The size of the instruments and incisions used in laparoscopy continues to shrink in time. When instruments smaller than 2 mm are used, it is called "Micro-Laparoscopy". In conventional laparoscopy, incisions range from 5-12 mm while in Mini-laparoscopy, which we also mentioned here, incisions are smaller than 5 mm.
The small incision required for laparoscopy has a less risk of infection than open surgery. The reduced risk of hernia, especially in overweight and obese patients, is another notable advantage. The same advantages apply to Mini-Laparoscopy, which is performed with even smaller instruments. In fact, there are much smaller scars on the skin compared to traditional laparoscopy because the entry is performed through a smaller area and without any incision. While the skin is sutured after surgery in classical laparoscopy, it does not need to be sutured in Mini-Laparoscopy as the incision area is very small.
Use of Mini-Laparoscopy in Surgery
Mini-laparoscopy can be used in various surgeries such as diagnostic laparoscopy, hysterectomy, myomectomy and prolapse surgeries. Trocars or instruments can be used alone or in addition to instruments of conventional size. These devices do not require incisions and are inserted into the abdominal cavity with an access needle.
A stainless steel instrument tip and stabilizing handle provide maximum strength for safety, retraction and tissue/organ manipulation. It is inserted with a small, fixed trocar, which provides cosmetic benefits. These instruments are reusable and thus cost-effective. They are designed for primary instrumentation and are lightweight. The trocars are 15 cm long and have silicone leaf valves and can be used in almost all interventions. Sealing of vessels to prevent bleeding can also be successfully performed with mini laparoscopic electrosurgical instruments (Olympus Gyrus 3 mm PKS MOLly forceps by Olympus, bipolar RoBI forceps by Karl Storz). No suturing is required for wound closure, they can be closed with steri-strips at the end of the operation.
Mini-laparoscopy is a good alternative to traditional laparoscopy for difficult "Endoscopic Gynecological surgeries” and has proven to be an easy technique for surgeons to learn. It increases patient satisfaction with a smaller incision and no need for sutures to close the skin.
Mini-laparoscopy has advantages for the patient such as significantly less postoperative pain and no visible scars. In addition, not requiring relearning due to similarities with standard laparoscopic surgical technique and instruments is its advantage for surgeons.